Physical Therapy

What is physical therapy?

Physical therapy, often called PT for short, uses exercise, physical activity, and other treatments like massage to help strengthen and heal a person's body and relieve pain after an injury, illness, or operation. It includes developing and improving balance, coordination, range of motion (movement of joints – the place where two bones meet) and gross motor skills (movements like rolling over, sitting, crawling, running and jumping that use the large muscles of the body). Another important role of physical therapy for children and teens is to aid in the growth and development of those who have experienced an injury, illness, or operation which may cause developmental delays. Physical therapy is also about preventing injury or damage to the body.

The goal of physical therapy is to improve or maintain a person's quality of life by building:

Strength. Before their intestinal transplant, your child's muscles may be weak. Your child may not be able to participate in physical activity because of his or her illness. Lying in bed after their intestine transplant also will weaken your child's muscles. It's important to keep those muscles strong using physical therapy. Physical therapy will build your child's muscles after his or her transplant. It will help strengthen your child's arms, legs, abdomen, and other parts of the body. Using weights is one way to build muscle strength.

Endurance. Because of his or her illness, your child may not have a lot of energy prior to intestine transplant. The transplant operation also will leave your child drained at first. Physical therapy will increase your child's stamina after the surgery. It will help give your child back the energy he or she needs to carry on day-to-day activities like sitting, walking, bathing, playing and getting back into a normal routine.

Flexibility. Physical therapy will improve your child's flexibility after their surgery. Your child's muscles may get stiff and tight from lying in a hospital bed for long periods of time. Stretching exercises develop flexibility and keep muscles from stiffening up. Flexibility will help your child move around more easily and without pain.

A physical therapist is someone whose job is to lead a person through physical therapy. Physical therapists are specially trained and licensed by the state to perform physical therapy.

Why does my child need physical therapy?

There are many reasons that a person might need physical therapy. You may have had physical therapy yourself, or know someone who has. If you've ever broken a bone you may have been to physical therapy to help you heal and get back into shape.

People in the hospital who have had operations usually need physical therapy, especially those who've had major surgery like an intestinal transplant. When you spend a lot of time lying in a hospital bed after an operation, you lose your strength, endurance, and flexibility. Your muscles weaken and tighten and you tire easily.

It may be hard for your child to move around, sit, stand, or walk immediately following his or her operation. It's important that your child's body doesn't forget how to move. Physical therapy will keep your child's body healthy and strong after his or her intestine transplant. It will help prevent your child's muscles from getting weak during the process of recovery.

Another benefit of physical therapy is that it may relieve some of your child's pain, and even prevent complications that could arise after surgery. Physical therapy improves your child's health by increasing his or her body's strength, flexibility, and endurance.

Because of illness, your child may not have been able to use all of his or her muscles before his or her intestinal transplant. It may have hurt to move certain ways. Physical therapy helps develop any muscles your child didn't use or that weren't used enough before your child's transplant.

It's especially important for infants, children and teenagers to have physical therapy after an intestinal transplant. Infants, children and teens are still growing and developing. Your child's disease or illness may have caused a developmental or growth delay. Your child may not be as tall or weigh as much as he or she should. Infants especially may not reach developmental milestones like rolling over and crawling.

Physical therapy can help overcome developmental or growth delays because of an illness. The physical therapist will work on skills that your child may not have had before intestinal transplantation; for example, lying on his or her stomach. Prior to an intestinal transplant, your child's stomach may have been swollen. Your child may have avoided lying on his or her stomach because it was too painful. If this is a problem, a physical therapist will teach your child how to lie comfortably on his or her stomach post-transplant.

When will my child have physical therapy?

You and your child's first encounter with physical therapy may be during the evaluation for your child's intestinal transplant. You will probably meet a physical therapist at that time. The physical therapist will evaluate your child. Depending on your child's medical condition, age, and current health status, the physical therapist may give your child an exercise plan to follow while waiting for his or her intestine transplant.

Exercising will help prepare your child for surgery. It will give him or her the energy and endurance needed for the operation and a speedier recovery. Depending on your child's age, some exercises that the physical therapist may recommend to do before intestinal transplant are walking, riding a bike, and swimming (unless your child has an ostomy). Even mall walking counts!

Be sure to talk to your child's transplant doctor, physical therapist or transplant coordinator if you would like your child to start exercising while he or she waits for an intestine transplant. It's good to exercise, but you don't want your child to get hurt. The transplant team will help develop an exercise plan that's safe and individualized for your child's needs.

Physical therapy is a very important part of your child's recovery and healing. Your child will begin physical therapy as soon as possible after his or her intestine transplant. The transplant team wants your child up and about quickly. Most children start physical therapy a day or two to a week after their transplant surgery. You child's physical therapist will work with other members of the transplant team to schedule physical therapy.

What will my child do during physical therapy?

During your child's first physical therapy session after his or her intestine transplant, the physical therapist will evaluate your child's strength, flexibility and endurance and develop a treatment plan. Each session is customized to your child's age, individual needs, and medical condition.

Basic movements like rolling over or sitting up may be difficult and painful for your child immediately following his or her surgery. Your child may have multiple incisions and tubes in his or her belly, along with some soreness and pain. The sessions will start out working with your child on basic movements. The sessions are progressive, meaning that each one builds on the last. For example, if your child is old enough to walk, following surgery he or she must be able to stand up before starting to walk.

If your child is an infant, the physical therapist will stretch out and work his or her muscles by gently moving them around. If your child is old enough to crawl, developmental activities may include placing a toy in front of the child and encouraging him or her to crawl to it. For older children and teens, they will gradually work on sitting up, then standing and finally walking and doing other physical activity. Your child may need a cane or other walking aid until he or she is stable on their own. Your child will also do stretching exercises and other physical activities to increase his or her strength, flexibility, and endurance.

When you think of physical therapy, you may think that it involves using specific exercises to accomplish its goals. Although some specific exercises may be used, most physical therapy for children and teens is accomplished through play with toys and games, and through physical activities like basketball or riding a bike.

The transplant team wants physical therapy to be fun for your child. He or she has been through a lot, so physical therapy may be hard – especially at first. After the first couple of times, your child may really enjoy physical therapy and actually look forward to it. It's a good break from lying in bed or sitting in the hospital room.

For infants and toddlers, physical therapy may only be in their hospital rooms, walking down the halls outside their room or in the playroom on the transplant unit (the place in the hospital where your child will stay after his or her intestinal transplant).

Children and teens may stick close to their rooms when first starting physical therapy and then move to the hospital gym. Your child may use a stationary bike, weights, a stair or step climber, balance beams, balls, a treadmill, toys, and games. Depending on your child's condition and interests, he or she may shoot basketball, play with a soccer ball, or play baseball or hockey. The physical therapists want your child to look forward to physical therapy. They want it to be interesting and fun!

Aerobic exercise builds endurance. Aerobic exercise is exercise that increases your muscles' need for and use of oxygen. It works out your cardiovascular system, which includes your heart and blood vessels. The extra oxygen your body gets during aerobic exercise makes the heart stronger and even larger. The heart is one big muscle. It needs exercise just like other muscles in the body. The stronger your heart, the more blood it will pump through your blood vessels and the more easily blood will move through them.

By doing aerobic exercise as part of physical therapy, your child will be able to maintain energy and strength for longer periods of time. The more endurance your child has, the less quickly he or she will tire. This goes for any physical activity, whether it's something simple like bathing and walking, or something that requires more energy – like sports. Some examples of aerobic exercise that your child might enjoy are walking, swimming, running, soccer, and basketball. Dancing and jumping rope are even aerobic exercises!

Physical therapy may include other treatments besides exercise and physical activity. The physical therapist may use heat, cold, massage or a warm whirlpool bath to help loosen up your child's muscles. He or she may also stimulate your child's muscles using electrical current. Electrical stimulation helps jump-start weak muscles. Electrical stimulation is not painful. It actually may feel good to your child, and help relieve muscle soreness and pain.

Each of your child's physical therapy sessions will last 30 to 45 minutes. They will be shorter at first, and lengthen as your child builds up endurance and energy. He or she may tire easily and have some pain during physical therapy, especially during the first sessions. As your child does the exercises and his or her body heals, he or she will have more energy and less discomfort. Although your child will have good days and bad, he or she will gradually feel stronger and better and be able to do more.

The more effort your child can put into physical therapy, the better. Help your child follow instructions and do (or at least try) all of the exercises and activities the physical therapist prescribes. Your child probably will have days when he or she doesn't feel like doing physical therapy. Even on these days, encourage your child to try to do a little. The more exercises your child does, the easier they will get. The more effort your child puts into their therapy, the more he or she will benefit from it.

Physical therapy benefits can extend beyond the physical; it can also help your child feel better about him or herself. Your child may realize that he or she will be able to do normal things again, and feel more optimistic and confident. These positive feelings, in turn, can also help speed recovery.

How long will my child go to physical therapy?

Depending on your child's age and recovery time, he or she will have physical therapy for one to three months after his or her intestine transplant. Some children finish their physical therapy while they're in the hospital or while they're staying in Pittsburgh after their transplant.

Other children, especially those under one year old, will continue their physical therapy when they return home. Because they are at a critical time for growth and development, infants and toddlers may need extra physical therapy to overcome or prevent any delays.

What happens after my child returns home?

Once you leave Pittsburgh, your child may have more physical therapy. Children under one and toddlers often need more therapy because they are at key points in their growth and development. If your child needs more therapy, the transplant team will help set it up for you with someone close to your home.

Even if your child doesn't need more physical therapy when you return home, it's a good idea for him or her to continue exercising. Physical activity is encouraged. It's a good way for your child to stay fit, feel good about his or her body, and take the focus off of being sick. Work with your child's physical therapist before you leave the hospital to create an exercise plan that your child can do at home without a physical therapist.

There are times when your child shouldn't exercise:

Right after eating

If he or she has a fever or an infection, like a cold or the flu

If he or she is really tired or just doesn't feel like him or herself

If he or she has a stoma and you notice increased output

If your child has pain or difficulty breathing when exercising or doing any physical activity, he or she should stop right away. If the pain doesn't stop, you should call your child's local doctor and his or her transplant coordinator.

There won't be many things that your child can't do after his or her intestinal transplant. He or she can play most sports. Just avoid anything that's too rough, like football or wrestling. Check with the physical therapist, transplant coordinator, or doctor to confirm what's acceptable, or whether or not your child should participate in an exercise or activity. Always call a member of the transplant team if you have any questions or worries.

If you child enjoys exercising and physical activity, you may want to think about participating in the Transplant Games. The Transplant Games are like the Olympics for transplant patients. Events include running, swimming, volleyball and even bowling. Your child may have fun joining your local Transplant Team at the Transplant Games!